RFP-OIG260145 Medical Record Review and Consultative Services (2nd Amendment)   3

The scope of the resulting contract(s) will include medical review and consultative services associated with the oversight activities of the OIG primarily involving Medicare fee-for-service payments. Occasionally it may include assessment of services and claims for Medicaid or Medicare Part D. Based on prior experience, the resulting contract(s) will require medical review of approximately 100-200 claims and associated medical records per audit and approximately 2,000-3,000 claims and associated medical records per annum, but actual workload under the resulting contract(s) could fluctuate based on potential future changes in OIG's budget, shifts in OIG's priorities, and other factors.

The scope of the resulting contract(s) will not include determining OIG priorities; identifying auditees and subject matter of audits; claims sampling; and establishing audit objectives, scope and methodology; however, OIG may in its discretion ask for input on these matters as part of consultative services (see below). OIG will collect claims data, medical records and other supporting documents in accordance with each audit's objectives. OIG will transmit those documents electronically through its secure file transfer system or occasionally in hard copy through the U.S. Postal Service or other parcel delivery service. The resulting contract(s) will not include responsibility for those functions.